Author + information
- Received October 12, 2014
- Revision received December 13, 2014
- Accepted December 23, 2014
- Published online March 10, 2015.
- W. Schuyler Jones, MD∗,†∗ (, )
- Xiaojuan Mi, PhD∗,
- Laura G. Qualls, MS∗,
- Sreekanth Vemulapalli, MD∗,†,
- Eric D. Peterson, MD, MPH∗,†,
- Manesh R. Patel, MD∗,† and
- Lesley H. Curtis, PhD∗,†
- ∗Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- †Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- ↵∗Reprint requests and correspondence:
Dr. W. Schuyler Jones, Duke University Medical Center, Box 3126, Durham, North Carolina 27710.
Background Peripheral vascular intervention (PVI) is an effective treatment option for patients with peripheral artery disease (PAD). In 2008, Medicare modified reimbursement rates to encourage more efficient outpatient use of PVI in the United States.
Objectives The purpose of this study was to evaluate trends in the use and clinical settings of PVI and the effect of changes in reimbursement.
Methods Using a 5% national sample of Medicare fee-for-service beneficiaries from 2006 to 2011, we examined age- and sex-adjusted rates of PVI by year, type of procedure, clinical setting, and physician specialty.
Results A total of 39,339 Medicare beneficiaries underwent revascularization for PAD between 2006 and 2011. The annual rate of PVI increased slightly from 401.4 to 419.6 per 100,000 Medicare beneficiaries (p = 0.17), but the clinical setting shifted. The rate of PVI declined in inpatient settings from 209.7 to 151.6 (p < 0.001), whereas the rate expanded in outpatient hospitals (184.7 to 228.5; p = 0.01) and office-based clinics (6.0 to 37.8; p = 0.008). The use of atherectomy increased 2-fold in outpatient hospital settings and 50-fold in office-based clinics during the study period. Mean costs of inpatient procedures were similar across all types of PVI, whereas mean costs of atherectomy procedures in outpatient and office-based clinics exceeded those of stenting and angioplasty procedures.
Conclusions From 2006 to 2011, overall rates of PVI increased minimally. However, after changes in reimbursement, PVI and atherectomy in outpatient facilities and office-based clinics increased dramatically, neutralizing cost savings to Medicare and highlighting the possible unintended consequences of coverage decisions.
This project was funded by American Heart Association Clinical and Mentored Population Science Research Grant #14CRP18630003. The content is solely the responsibility of the authors and does not necessarily represent the official views of the American Heart Association. Dr. Jones has received research grants from AstraZeneca, Boston Scientific, Bristol-Myers Squibb, the American Heart Association, and Daiichi Sankyo. Dr. Vemulapalli has received research grants from Boston Scientific. Dr. Peterson has received research grants from American College of Cardiology, American Heart Association, Eli Lilly & Co., Janssen Pharmaceutical Products, Society of Thoracic Surgeons; and serves as a consultant/on the advisory board for AstraZeneca, Bayer AG, Boehringer Ingelheim, Janssen Pharmaceutical Products, Merck & Co., and Sanofi. Dr. Patel has received research grants from AstraZeneca, Johnson & Johnson, Maquet, the National Heart, Lung, and Blood Institute, and Pluristem; and has served as a consultant/on the advisory board for Baxter, Bayer, Genzyme, and Ortho-McNeil-Janssen. Dr. Curtis received research grants from GlaxoSmithKline, Boston Scientific, Novartis, and Amgen. Drs. Mi and Qualls have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 12, 2014.
- Revision received December 13, 2014.
- Accepted December 23, 2014.
- American College of Cardiology Foundation